- Humana (Columbus, OH)
- …(Research Process) **Use your skills to make an impact** **Required Qualifications** + Registered Nurse ( RN ) license + Associate's or Bachelor's Degree ... Professional 2 performs clinical reviews and supports the staff involved in HEDIS hybrid season review . The Quality Compliance Nurse works to gain more… more
- Insight Global (Philadelphia, PA)
- …patient's care needs. The HEDIS nurse focuses solely on using HEDIS measuring criteria to review health plans in accordance with healthcare facility ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Previous HEDIS review experience Active RN License… more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- Providence (OR)
- …facilitation, data analysis and or case review + Experience working as a Nurse supporting a minimum of one HEDIS Audit season **Why Join Providence Health ... specifications for the Healthcare Effectiveness and Data Information Set ( HEDIS ) program + Conduct Audits, which include review...this position include:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical… more
- Actalent (Iowa City, IA)
- Job Title: HEDIS Nurse Job Description + We...standards and/or custom or other measure set standards * Review medical records and abstract data for HEDIS ... are seeking a dedicated and meticulous HEDIS Nurse to assist with the collection,...Perform other quality initiatives as necessary Hard Skills + HEDIS + RN + Experience with … more
- The Cigna Group (Philadelphia, PA)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...and participates in patient education and outreach tied to HEDIS initiatives 4. Works to improve access to care… more
- ERP International (Fallon, NV)
- **Overview** ERP International is seeking a ** Registered Nurse ( RN ) Health Educator** for a full-time position in support of the **Naval Health Clinic ... conjunction with performing ambulatory nursing duties. Duties as a RN require a full range of knowledge and skill...review and make recommendations as necessary to improve Hedis data. Input data to the DD2766 automated flow… more
- University of Miami (Miami, FL)
- …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Advanced Practice Registered Nurse General Internal Medicine ... day/night Saturday and Sunday, when necessary) The Advanced Practice Registered Nurse (APRN) d elivers medical care...of Medicare annual wellness exam documentation + Knowledge of HEDIS Quality Care Gaps - review and… more
- TEKsystems (Baltimore, MD)
- … HEDIS and overread review is essential for this role. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure ... Description: PURPOSE: The Clinical Medical Review Nurse an RN ...- Advanced Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced… more
- Ventura County (Ventura, CA)
- …care services to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing ... amount of supervision commensurate with their experience. PAYROLL TITLE: Senior Registered Nurse - Ambulatory Care AGENCY/DEPARTMENT: Health Care Agency… more
- The Cigna Group (Harlingen, TX)
- …case-management or utilization management position (experience can be a combination of LVN/ RN licensure) * Previous HEDIS and/or CMS STARs experience a ... manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to… more
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting ... thorough HEDIS overreads in line with NCQA guidelines. Additional tasks...go onsite in Baltimore, MD Must have LPN or RN Responsibilities: + Accurately and efficiently over-read medical record… more
- Commonwealth Care Alliance (Boston, MA)
- …etc. + Identify and initiate a plan to meet quality, STAR, and HEDIS measures. + Conduct Annual Visits with patients, taking a detailed history, performing ... or hospitalization. Such visits include a detailed history of present illness, review of systems, physical exam, ordering of appropriate studies and tests,… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more
- CVS Health (Dallas, TX)
- …expense reimbursement policy. Preferred Qualifications : Oklahoma residency preferred Oklahoma-licensed registered nurse preferred OR be certified as a Certified ... accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member… more
- Fallon Health (Springfield, MA)
- …related field preferred **License/Certifications:** + Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable ... providers and office staff and may lead care plan review with providers and care team as applicable +...**Experience:** + 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- AdventHealth (Westwood, KS)
- …Data Analysis related to healthcare. **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . Registered Nurse **Preferred qualifications:** . Registered ... current expertise on quality measures (including but not limited to ACO, CMS, HEDIS etc) . Support and maintain outreach initiatives and other quality improvement… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and...Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition… more
- CVS Health (Chicago, IL)
- …development, modeling inclusive behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + ... of the Quality team to ensure maximal performance with HEDIS and accreditations. + Serving as the SPOC on...such as monitoring report owners and the timely quality review of these reports and works with COO and… more
- CVS Health (Atlanta, GA)
- …- Strong communication skills - Critical thinking skills **Preferred Qualifications** - Registered Nurse - 2 years experience working with Medicaid or ... These education sessions will engage and educate providers in understanding EES, HEDIS , improving measure results, closing gaps in care, and more. + Support… more